A neurology education blog from Dr Holland

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Tremor

Tremor is characterized by involuntary rhythmic to-and-fro movements (oscillations or twitching) of a body part, most commonly affecting the hands and arms, but sometimes also the eyes, face, head, vocal folds, trunk, and legs.

“Do I have Parkinson’s disease?” is the first question we always get asked. This is usually pretty easy to answer. Parkinson’s tremor is often much worse on one side, present at rest, goes away with movement, and is seen (along with reduced swing) when the arm hangs by the side walking:

In contrast “benign” essential tremor affects both sides equally, and is most evident with movement. There may be a family history and it sometimes gets a little better with alcohol:

However, “benign” essential tremor is not always so benign. It can be embarrassing and disabling – severely affected patients can become afraid to feed themselves or write in public:

Essential tremor can improve with some oral medications, like Propranolol, but in many cases the oral medications are either ineffective or cause side effects. This type of recalcitrant essential tremor can respond to a surgical procedure such as deep brain stimulation:

However, deep brain stimulation is a surgical procedure, and may not be an option for patients taking blood thinners or those with cognitive issues. These patients, with medically resistant essential tremor who cannot get deep brain stimulation, can still benefit from stereotactic radiosurgery using our new gamma knife: